Nurse Case Manager

VIVA USA Inc; Falls Church (VA); Hybrid; USD 70,000 - 100,000; Full time

Job summary

VIVA USA Inc in Falls Church, VA seeks an RN Case Manager to assess needs and coordinate benefits and services for individuals. You will work telephonically and in the field to promote optimal, cost-effective outcomes with a collaborative approach.

This role requires 3 years of clinical experience and an active VA or compact RN license; the position follows a Mon-Fri schedule with a mix of telephonic and field responsibilities.

Qualifications

• Active, unrestricted RN license in VA or compact license.
• Minimum 3 years clinical practice experience.
• Case management experience preferred; strong communication and multitasking.

Responsibilities

• Assess referred member needs and determine approach to case resolution.
• Apply criteria, guidelines, policies, and procedures to assess benefits and administer services.
• Utilize case management and quality processes in compliance with regulatory standards.

Skills

Verbal communication

Written communication

Multitasking

Prioritization

Education

RN license VA or compact

CCM certification preferred

Tools

Electronic health records (EHR) systems

Job description

Telephonic and Field work.

Position Summary

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

Requires an RN with unrestricted active license in VA with no history

Duties

• Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services
• Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
• Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures

Experience

• 3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required.
• Healthcare and/or managed care industry experience.
• Case Management experience preferred-- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
• Effective communication skills, both verbal and written.
• Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
• Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
• Typical office working environment with productivity and quality expectations

Education

• RN with current unrestricted state licensure state of VA or compact license
• Case Management Certification CCM preferred

Notes

• Must have an active and unrestricted RN license in VA or compact license.
• Mon-Fri 8:00 AM-5:00 PM
• Telephonic and Field work. Candidates will need a quiet, dedicated work space with no distractions.

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status